THE LAST WORD ON CIRCUMCISION
Cecil continues to get denunciations from opponents of routine infant circumcision (January 28, March 25) who feel that if you're not adamantly against this procedure you're in favor of it. Cecil despairs of making any headway against this attitude, but will say yet again that in his view, and so far as he can tell in the view of the medical establishment, no compelling argument can be made either way. Done properly, routine infant circumcision is a minor medical procedure involving small risks and offering small benefits. There is no strict need for it and it persists mostly as a matter of cultural ritual. If the thought of having your kid snipped horrifies you and you don't want to do it, OK by me. On the other hand, if you do have it done, you're hardly a human rights violator.
Cecil will also cheerfully concede that while the immediate risk of complications from circumcision is low, there have been few if any long-term follow-ups. Some opponents of the procedure are inclined to blame every sexual problem they have ever had on circumcision, but others do have specific, and, on the face of it, legitimate complaints, mainly in the area of skin tightness, adhesions, etc. It also seems plausible, though again there is little data, that circumcision results in a loss of sensitivity in the tip of the penis due to abrasion from clothing. If research, and not merely anecdotal accounts, were to demonstrate that circumcised males have significantly more sexual problems than uncircumcised ones, Cecil would speedily revise his opinion of the practice.
Having thus attempted to mollify the anticirc crowd, let me address a few other assertions before we put this to rest:
A 1966 study (Patel, Journal of the Canadian Medical Association) found there were complications in 35 percent of circumcisions. Patel's results are far out of line with other research. An English doctor (Williams, British Journal of Surgery, 1993), no fan of circumcision, says "a realistic figure" is a still high 2 to 10 percent, but this is based in part on studies of postinfancy circumcisions, which are more traumatic. Ronald Poland, an opponent of circumcision, conceded that "the risks of circumcision are very small when the procedure is performed by an experienced practitioner" (New England Journal of Medicine, 1990).
The foreskin is not "basically ordinary skin," as I wrote; the inner layer is mucocutaneous tissue, which is found in junctions between the inside and outside of the body. Dermatologist R.K. Winkelmann (1960) says the mucocutaneous nerve-end organ is the primary organized sensory ending of the body. Winkelmann's view of the primacy of the mucocutaneous end organ is idiosyncratic. The role and importance of the various types of cutaneous nerve endings are still a matter of conjecture. In any case the glans penis (tip) is also mucocutaneous tissue.
It's a human rights issue. You should let your son decide for himself if he wants to be circumcised. It's not that simple. Some men not circumcised as infants--5 to 10 percent is the range often cited, but this is subject to dispute--will require circumcision for medical reasons later in life. Circumcision after infancy is far more traumatic and expensive and has a much higher rate of complications than infant circumcision.
Penile cancer, the likelihood of which is greatly reduced by circumcision, is rare in the U.S. It is, but of course circumcision proponents will argue that this is because most American men are circumcised. The more telling argument is that while penile cancer is fairly common in some developing countries, it is rare in Scandinavia, where infant circumcision is unknown. This leads us to speculate that penile cancer is related not to the foreskin per se but to poor foreskin hygiene. If you can adopt a Scandinavian forthrightness in teaching your son to clean his penis, therefore, you may well eliminate the risk of penile cancer. One suspects, however, that the reason circumcision hasn't gone the way of the tonsillectomy is that the typical circumcised American male thinks foreskins, smegma, etc, are icky and doesn't relish the thought of having to instruct his son in how to care for something he personally has never given a moment's thought.
Art accompanying story in printed newspaper (not available in this archive): illustration/Slug Signorino.